Healthcare Provider Details

I. General information

NPI: 1538063144
Provider Name (Legal Business Name): CRYSTAL PINEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 EL MOLINO BLVD
LAS CRUCES NM
88005-2915
US

IV. Provider business mailing address

2050 CRESCENT DR
LAS CRUCES NM
88005-3321
US

V. Phone/Fax

Practice location:
  • Phone: 575-323-8900
  • Fax: 575-267-6228
Mailing address:
  • Phone: 575-323-8900
  • Fax: 575-267-6228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB20260584
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: